NPIMap

Organization Active NPI

Blue Water Medical PLLC

  • Clinic/Center
  • Port Huron, MI
National Provider Identifier
1336409192
Registry record updated May 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
4301093347 Issued in MI
Legal business name
BLUE WATER MEDICAL PLLC
Practice address
511 Fort St
Suite 102
Port Huron, MI 48060-3922
Phone
(810) 479-4769
Fax
(888) 414-4545
NPI assigned
May 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marcus K. Free, M.D.
Title
President/Member
Phone
(810) 479-4769

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 4301093347 MI Primary

Addresses

Primary practice location

511 Fort St
Suite 102
Port Huron, MI 48060-3922

Mailing address

511 Fort St
Suite 102
Port Huron, MI 48060-3922
Phone (810) 479-4769

National Provider Directory

National Provider Directory

Locations

511 Fort St
Rm 102
Port Huron, MI 48060
Phone (810) 479-4769

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337904000000",
    "number": "1336409192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 FORT ST",
            "address_2": "SUITE 102",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603922",
            "telephone_number": "810-479-4769",
            "fax_number": "888-414-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 FORT ST",
            "address_2": "SUITE 102",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603922",
            "telephone_number": "810-479-4769",
            "fax_number": "888-414-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-25",
        "last_updated": "2012-05-25",
        "status": "A",
        "authorized_official_last_name": "FREE",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT/MEMBER",
        "authorized_official_telephone_number": "810-479-4769",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MI",
            "license": "4301093347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.